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Updated: 03/03/2015

Utilization Review Supervisor:
Plans, organizes, and supervises, under general direction, the activities of the Utilization Review unit of a hospital. Ensures compliance with reimbursement rules of third-party payers. Performs the more complex utilization review work. Monitors and ensures hospital compliance with Medic-Cal, Medicare,... [+] More

Utilization Review Supervisor:
Plans, organizes, and supervises, under general direction, the activities of the Utilization Review unit of a hospital. Ensures compliance with reimbursement rules of third-party payers. Performs the more complex utilization review work. Monitors and ensures hospital compliance with Medic-Cal, Medicare, and insurance reimbursement policies, the maintenance of patient care quality, and the maximizing of reimbursements for services provided. Reports to the Hospital Quality Assurance Manager. Plans, organizes, and supervises the staff of the Utilization Review unit. Reviews and analyzes government and accrediting agency standards governing admissions, treatment, and continued stay of patients. Develops policies and procedures for adherence to governmental and accrediting agency standards. Coordinates the work of the Utilization Review staff with medical staff to ensure appropriate and timely patient care action and to maximize reimbursement. Analyzes individual patient records to determine appropriateness of admission. Reviews patient treatment plans for adherence to established criteria and standards. Refers cases that fail to meet criteria to the Patient Care Review Committee for review and course of action. Conducts studies and prepares reports for the review committee, medical staff, and administration. Serves as review committee liaison with other committees to coordinate formulation of policy and procedures. Explains procedures and documentation requirements to medical staff, managers, and other hospital personnel. Interviews, selects, trains, and evaluates Utilization Review staff. [-] Less

Cost of Living Data

A renter's cost of living for someone making $38,394 in Holly Springs, North Carolina is 106.4% of the US National Average. For more information, or to compare cost of living data between two cities, click here.

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